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Tai SM, Munir S, Walter WL, Pearce SJ, Walter WK, Zicat BA. Squeaking in large diameter ceramic-on-ceramic bearings in total hip arthroplasty. J Arthroplasty 2015; 30:282-5. [PMID: 25304938 DOI: 10.1016/j.arth.2014.09.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 09/11/2014] [Accepted: 09/12/2014] [Indexed: 02/01/2023] Open
Abstract
We analyzed the results of 206 consecutive total hip arthroplasties performed using large diameter ceramic-on-ceramic bearings. At an average follow-up of 28months, the mean Harris Hip Score improved from 54 to 92. Fifteen (7.3%) hips were noted to squeak. There was no significant difference between silent and squeaking hips with regards to age, weight, height, BMI, range of movement, femoral head diameter, leg length, and offset or center of rotation. No correlation was present between incidence of squeaking and increasing cup inclination and anteversion. 5.2% of cups orientated within Lewinnek's safe zone squeaked. No hips required revision for squeaking. While large diameter ceramic bearings may produce squeaking, our early results of surgery using large head ceramic bearings are encouraging. However, long-term follow-up is required.
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Affiliation(s)
- Stephen M Tai
- Specialist Orthopaedic Group, North Sydney, New South Wales, Australia
| | - Selin Munir
- Specialist Orthopaedic Group, North Sydney, New South Wales, Australia
| | - William L Walter
- Specialist Orthopaedic Group, North Sydney, New South Wales, Australia
| | - Simon J Pearce
- Specialist Orthopaedic Group, North Sydney, New South Wales, Australia
| | - William K Walter
- Specialist Orthopaedic Group, North Sydney, New South Wales, Australia
| | - Bernard A Zicat
- Specialist Orthopaedic Group, North Sydney, New South Wales, Australia
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Abstract
BACKGROUND Ceramic-on-ceramic bearing surfaces were developed to provide an alternate to metal-on-polyethylene to decrease wear-induced osteolysis in total hip arthroplasty patients. In an effort to decrease the risk of ceramic acetabular component fracture or damage during implantation, a raised metal rim was added. QUESTIONS/PURPOSES How many fractures or impingements have occurred in our population of patients with ceramic liners with raised rims? METHODS With IRB-approved consent, a case series was reviewed from a single center registry and 4 of 169 patients were identified who had revision hip surgery with the ceramic liner with a raised metal rim: one for ceramic liner fracture and three for metallosis, pain, and squeaking. Implant alignment and operative findings were reviewed. RESULTS One ceramic liner fracture and three cases of metallosis from impingement of the femoral neck on the posterior elevated metal rim of the acetabular liner were observed at revision. The femoral neck in each patient had a divot that corresponded to a divot in the posterosuperior liner rim. Three of the four patients had audible squeaking or clicking prior to revision. A total of 3% of patients in this series had clinically significant impingement with this implant type. CONCLUSION Acoustic phenomenon in a ceramic on ceramic bearing surface should be investigated with a cross-table lateral radiograph to evaluate component position. If symptomatic impingement is demonstrated, revision should be considered to avoid failure from metallosis or fracture.
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Lee YK, Ha YC, Koo KH. Comparison between 28 mm and 32 mm ceramic-on-ceramic bearings in total hip replacement. Bone Joint J 2014; 96-B:1459-63. [DOI: 10.1302/0301-620x.96b11.34358] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Large femoral heads have become popular in total hip replacement (THR) as a method of reducing the risk of dislocation. However, if large heads are used in ceramic-on-ceramic THR, the liner must be thinner, which may increase the risk of fracture. To compare the rates of ceramic fracture and dislocation between 28 mm and 32 mm ceramic heads, 120 hips in 109 patients (51 men and 58 women, mean age 49.2 years) were randomised to THR with either a 28 mm or a 32 mm ceramic articulation. A total of 57/60 hips assigned to the 28 mm group and 55/60 hips assigned to the 32 mm group were followed for at least five years. No ceramic component fractures occured in any patient in either group. There was one dislocation in the 32 mm group and none in the 28 mm group (p = 0.464). No hip had detectable wear, focal osteolysis or prosthetic loosening. In our small study the 32 mm ceramic articulation appeared to be safe in terms of ceramic liner fracture. Cite this article: Bone Joint J 2014;96-B:1459–63.
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Affiliation(s)
- Y. K. Lee
- Department of Orthopaedic Surgery, Seoul
National University Bundang Hospital, 82 Gumi-ro, 173
beon-gil, Bundang-gu, Seongnam
463-707, South Korea
| | - Y. C. Ha
- Department of Orthopaedic Surgery, Chung-Ang
University College of Medicine, 221 Heukseok-dong, Dongjak-gu, Seoul, 156-756, South
Korea
| | - K. H. Koo
- Department of Orthopaedic Surgery, Seoul
National University Bundang Hospital, 82 Gumi-ro, 173
beon-gil, Bundang-gu, Seongnam
463-707, South Korea
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54
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Bearing surfaces in hip replacement - Evolution and likely future. Med J Armed Forces India 2014; 70:371-6. [PMID: 25382913 DOI: 10.1016/j.mjafi.2014.04.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 04/30/2014] [Indexed: 11/23/2022] Open
Abstract
Total hip arthroplasty has evolved from the first total hip arthroplasty in 1938, through the revolutionization of hip arthroplasty by principles of low friction arthroplasty introduced by Sir John Charnley in 1960s to the present state of the art implants and techniques. The main concern regarding failure of total hip arthroplasty has been the biological response to particulate polyethylene debris generated by conventional metal on polyethylene bearing surfaces leading to osteolysis and aseptic loosening of the prosthesis. Therefore, recent research has been focussing on alternative bearing surfaces to reduce the particulate debris generated. These bearing surfaces include ceramic-polyethylene, metal-metal as well as ceramic-ceramic articulations and have demonstrated lesser friction rates as well as significantly lower wear rates as compared to widely used metal on polyethylene surfaces. Clinical experience until now has shown that metal on metal articulations have significant safety concerns whereas metal-on-highly crosslinked polyethylene, ceramic on ceramic and ceramic on highly crosslinked polyethylene articulations have shown encouraging results to hold promise for wider use in younger and more active patients. This review article discusses positives and drawbacks of various bearing surfaces in current clinical use in total hip arthroplasty as well as briefly explores the newer technologies on the horizon which may even further decrease wear and improve total hip arthroplasty survivorship.
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55
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Lee TH, Moon YW, Lim SJ, Park YS. Meta-analysis of the Incidence and Risk Factors for Squeaking after Primary Ceramic-on-ceramic Total Hip Arthroplasty in Asian Patients. Hip Pelvis 2014; 26:92-8. [PMID: 27536565 PMCID: PMC4971122 DOI: 10.5371/hp.2014.26.2.92] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 05/08/2014] [Accepted: 05/30/2014] [Indexed: 12/12/2022] Open
Abstract
Purpose The purpose of this study was to assess the squeaking incidence and risk factors after primary ceramic-on-ceramic total hip arthroplasty (THA) in Asian patients using meta-analysis. Materials and Methods We performed a meta-analysis of published data on the squeaking incidence and risk factors from 2000 to 2013. Eight studies in Asians were analyzed for both squeaking incidence and risk factors and 25 studies in Western patients were analyzed for squeaking incidence. The data collected were: patient factors, surgical factors and implantation factors. Results The overall incidence of hip squeaking was 2.7% in Asians and 3.1% in Westerners. This difference was not statistically significant. The only significant risk factor was an increase in the acetabular cup abduction angle. Of the factors, the cup abduction angle was the only significant risk factor for the occurrence rate of squeaking, and the occurrence rate tended to increase with increasing angle. Conclusion The incidence of squeaking in Asians after primary ceramic-on-ceramic THA is 2.7% and is similar to that in Westerners. The increased cup abduction angle is associated with squeaking; therefore, surgeons should be careful not to implant the cup at a too steep abduction angle.
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Affiliation(s)
- Tae-Hun Lee
- Department of Orthopedic Surgery, Pohang St. Mary's Hospital, Pohang, Korea
| | - Young-Wan Moon
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Jae Lim
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Youn-Soo Park
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Sariali E, Klouche S, Mamoudy P. Ceramic-on-ceramic total hip arthroplasty: is squeaking related to an inaccurate three-dimensional hip anatomy reconstruction? Orthop Traumatol Surg Res 2014; 100:437-40. [PMID: 24736014 DOI: 10.1016/j.otsr.2014.01.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 01/14/2014] [Accepted: 01/31/2014] [Indexed: 02/02/2023]
Abstract
Many factors were incriminated in the squeaking generation in ceramic-on-ceramic total hip arthroplasty (THA), including the cup positioning and design. However, the influence of the stem orientation has not been investigated and the true three-dimensional hip anatomy has never been compared to the contralateral healthy hip. Three patients, who underwent unilateral ceramic-on-ceramic THA, complained of squeaking. CT-scans were performed to compare the true three-dimensional hip anatomy to the contralateral healthy hip. All patients presented evidence of posterior neck-rim impingement with a two-fold increase in the global anteversion (above 75°) comparatively to the healthy hip. The excess of anteversion was on the cup side in 2 cases and on the stem side in 1 case. We conclude that squeaking in ceramic-on-ceramic THA could be related to a poor accuracy of 3D hip anatomy reconstruction which generated a posterior impingement and subsequent anterior edge loading because of excessive global anteversion.
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Affiliation(s)
- E Sariali
- Service d'orthopédie traumatologique, hôpital Pitié-Salpétrière, 83, boulevard de l'Hôpital, 75013 Paris, France.
| | - S Klouche
- Service d'orthopédie traumatologique, hôpital Pitié-Salpétrière, 83, boulevard de l'Hôpital, 75013 Paris, France
| | - P Mamoudy
- Hôpital la Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
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57
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Owen DH, Russell NC, Smith PN, Walter WL. An estimation of the incidence of squeaking and revision surgery for squeaking in ceramic-on-ceramic total hip replacement: a meta-analysis and report from the Australian Orthopaedic Association National Joint Registry. Bone Joint J 2014; 96-B:181-7. [PMID: 24493182 DOI: 10.1302/0301-620x.96b2.32784] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Squeaking arising from a ceramic-on-ceramic (CoC) total hip replacement (THR) may cause patient concern and in some cases causes patients to seek revision surgery. We performed a meta-analysis to determine the incidence of squeaking and the incidence of revision surgery for squeaking. A total of 43 studies including 16,828 CoC THR that reported squeaking, or revision for squeaking, were entered into the analysis. The incidence of squeaking was 4.2% and the incidence of revision for squeaking was 0.2%. The incidence of squeaking in patients receiving the Accolade femoral stem was 8.3%, and the incidence of revision for squeaking in these patients was 1.3%.
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Affiliation(s)
- D H Owen
- Trauma and Orthopaedic Research Unit, Building 6 Level 1, The Canberra Hospital, PO Box 11, Woden ACT, 2606, and Australian National University Medical School, Level 2, Peter Baume Building 42, Linnaeus Way, Canberra, ACT, 0200, Australia
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58
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Abdel MP, Heyse TJ, Elpers ME, Mayman DJ, Su EP, Pellicci PM, Wright TM, Padgett DE. Ceramic liner fractures presenting as squeaking after primary total hip arthroplasty. J Bone Joint Surg Am 2014; 96:27-31. [PMID: 24382721 DOI: 10.2106/jbjs.m.00737] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Squeaking after ceramic-on-ceramic total hip arthroplasty is a relatively uncommon phenomenon. It usually does not require treatment in the absence of pain, mechanical symptoms, and/or relentless squeaking. The purpose of this investigation was to report on four patients who presented with hip pain and squeaking due to fractured ceramic liners after ceramic-on-ceramic total hip arthroplasty. METHODS Four patients with painful squeaking after ceramic-on-ceramic total hip arthroplasty were seen at our institution. One patient had a revision for suspected loosening and excessive anteversion of the cup noted on radiographs and magnetic resonance imaging (MRI). The remaining three patients had a revision for audible squeaking with progressive pain. RESULTS Intraoperatively, the ceramic liners of all four patients were fractured. CONCLUSIONS Squeaking after ceramic-on-ceramic total hip arthroplasty rarely is a functional issue. However, painful squeaking without notable trauma may indicate fracture of the ceramic liner. Painful squeaking is difficult to evaluate by conventional imaging. When painful squeaking occurs, exploration via surgical revision is recommended in selected patients, as ceramic liner fractures may go unnoticed on radiographs and/or MRI and thus their actual prevalence may be higher than estimated.
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Affiliation(s)
- Matthew P Abdel
- Adult Reconstruction and Joint Replacement Division (M.P.A., T.J.H., D.J.M., E.P.S., P.M.P., and D.E.P.) and Department of Biomechanics (M.E.E. and T.M.W.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for D.E. Pa
| | - Thomas J Heyse
- Adult Reconstruction and Joint Replacement Division (M.P.A., T.J.H., D.J.M., E.P.S., P.M.P., and D.E.P.) and Department of Biomechanics (M.E.E. and T.M.W.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for D.E. Pa
| | - Marcella E Elpers
- Adult Reconstruction and Joint Replacement Division (M.P.A., T.J.H., D.J.M., E.P.S., P.M.P., and D.E.P.) and Department of Biomechanics (M.E.E. and T.M.W.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for D.E. Pa
| | - David J Mayman
- Adult Reconstruction and Joint Replacement Division (M.P.A., T.J.H., D.J.M., E.P.S., P.M.P., and D.E.P.) and Department of Biomechanics (M.E.E. and T.M.W.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for D.E. Pa
| | - Edwin P Su
- Adult Reconstruction and Joint Replacement Division (M.P.A., T.J.H., D.J.M., E.P.S., P.M.P., and D.E.P.) and Department of Biomechanics (M.E.E. and T.M.W.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for D.E. Pa
| | - Paul M Pellicci
- Adult Reconstruction and Joint Replacement Division (M.P.A., T.J.H., D.J.M., E.P.S., P.M.P., and D.E.P.) and Department of Biomechanics (M.E.E. and T.M.W.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for D.E. Pa
| | - Timothy M Wright
- Adult Reconstruction and Joint Replacement Division (M.P.A., T.J.H., D.J.M., E.P.S., P.M.P., and D.E.P.) and Department of Biomechanics (M.E.E. and T.M.W.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for D.E. Pa
| | - Douglas E Padgett
- Adult Reconstruction and Joint Replacement Division (M.P.A., T.J.H., D.J.M., E.P.S., P.M.P., and D.E.P.) and Department of Biomechanics (M.E.E. and T.M.W.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for D.E. Pa
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Imbuldeniya AM, Pearce SJ, Walter WL, Zicat BA, Walter WK. Squeaking: Current knowledge and how to avoid it. Curr Rev Musculoskelet Med 2013; 6:342-9. [PMID: 23925448 PMCID: PMC4094095 DOI: 10.1007/s12178-013-9181-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This review aims to update the reader with current thinking and research related to the well documented phenomenon of squeaking hip arthroplasties. The etiology of squeaking is multifactorial and still not well understood. We aim to share our own experience and views on the combination of factors we believe increases the likelihood of squeaking, along with mechanisms by which the sound may be generated. Recent published findings from other groups are summarized along with an appropriate management algorithm we recommend for this cohort of patients.
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Affiliation(s)
- Arjuna M Imbuldeniya
- Specialist Orthopaedic Group, Mater Clinic Suite 1.08, 3-9 Gillies St, North Sydney, New South Wales, 2060, Australia,
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60
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Vibration transfer in the ball–stem contact interface of artificial hips. Med Eng Phys 2013; 35:1513-7. [DOI: 10.1016/j.medengphy.2013.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 01/20/2013] [Accepted: 04/07/2013] [Indexed: 11/21/2022]
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Abstract
Total hip arthroplasty is an effective treatment option for advanced hip arthritis in elderly patients. Studies in young patients have traditionally shown less durable results. With current implants, surgical technique, and cementless fixation methods, the durability of total hip arthroplasty may now be related to the wear performance of the bearing surfaces. To improve implant longevity, there are several bearing surface choices currently available for this demanding group of patients. Alternatives must be evaluated in terms of the risks and benefits associated with each articulation, and all new technologies must be carefully monitored over the long term.
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62
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Sanders AP, Brannon RM. A simple surrogate test method to rank the wear performance of prospective ceramic materials under hip prosthesis edge-loading conditions. J Biomed Mater Res B Appl Biomater 2013; 102:311-21. [DOI: 10.1002/jbm.b.33009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Revised: 06/01/2013] [Accepted: 07/15/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Anthony P. Sanders
- Department of Mechanical Engineering; University of Utah; Salt Lake City Utah 84112
- Ortho Development Corp.; 12187 S. Business Park Dr. Draper Utah 84020
| | - Rebecca M. Brannon
- Department of Mechanical Engineering; University of Utah; Salt Lake City Utah 84112
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63
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Brandt JM, Gascoyne TC, Guenther LE, Allen A, Hedden DR, Turgeon TR, Bohm ER. Clinical failure analysis of contemporary ceramic-on-ceramic total hip replacements. Proc Inst Mech Eng H 2013; 227:833-46. [DOI: 10.1177/0954411913489803] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The present study investigates the performance of ceramic-on-ceramic total hip replacements by combining a retrieval analysis with a survivorship analysis to elucidate mechanisms that led to clinical failure. Semiquantitative surface damage assessment, contact profilometry, contour measurements, and scanning electron microscopy were performed to characterize the types and quantify the extent of surface damage on the retrieved ceramic components. The implantation period was positively correlated with both damage scores of the femoral heads (R = 0.573, p < 0.001) and the acetabular cups (R = 0.592, p < 0.001). Increased maximal out-of-roundness values of the femoral heads correlated with both increased metal transfer damage score (R = 0.384, p = 0.023) and increased stripe damage score (R = 0.729, p ≤ 0.001) of the acetabular liners. The damage rate (damage score/year) for both the retrieved heads and acetabular liners was at least 2.2-fold greater at inclination angles of >45° than the damage rate at inclination angles of ≤45°. For the retrieved femoral heads only, the linear wear rate of 25.5 ± 21.3 µm/year at inclination angles of >45° was 6-fold greater than the linear wear rate of 4.2 ± 2.3 µm/year at inclination angles of ≤45°. Metal transfer on the ceramic bearing surface could possibly contribute to fluid-film starvation and, in combination with an increased inclination angle, may facilitate an adhesive wear mechanism associated with stripe surface damage. At our institution, the clinical survivorship of ceramic-on-ceramic total hip replacements was 98.9% (a total of 9 out of 815 patients were revised within 10 years after total hip arthroplasty) with revision as the end point, suggesting their safe use in younger patients.
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Affiliation(s)
- Jan-M Brandt
- Concordia Joint Replacement Group, Winnipeg, MB, Canada
| | | | | | - Andrew Allen
- School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada
| | | | - Thomas R Turgeon
- Concordia Joint Replacement Group, Winnipeg, MB, Canada
- Orthopaedic Innovation Centre, Inc., Winnipeg, MB, Canada
| | - Eric R Bohm
- Concordia Joint Replacement Group, Winnipeg, MB, Canada
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Kiyama T, Kinsey TL, Mahoney OM. Can squeaking with ceramic-on-ceramic hip articulations in total hip arthroplasty be avoided? J Arthroplasty 2013; 28:1015-20. [PMID: 23540532 DOI: 10.1016/j.arth.2012.10.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Revised: 06/24/2012] [Accepted: 10/12/2012] [Indexed: 02/01/2023] Open
Abstract
Squeaking is a recognized complication of total hip arthroplasty with ceramic on ceramic bearings but the etiology has not been well identified. We evaluated 183 hips in 148 patients who had undergone ceramic-on-ceramic noncemented total hip arthroplasties at one center between 1997-2007 by standardized telephone interviews and radiographic review. Audible squeaking was reported from 22 hips (12% of 183) of 19 patients. Prevalence of squeaking was associated with younger age; obesity; lateralized cup position; use of beta titanium alloy femoral components and shortened head length options; and higher reported activity level, greater pain, and decreased satisfaction at the time of the interview. Squeaking was described as having little personal significance by most patients. Squeaking might be preventable in part through medialization of the acetabular cup and avoidance of the use of shortened femoral necks.
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Affiliation(s)
- Takahiko Kiyama
- Department of Orthopaedic Surgery, Fukuoka Sano Hospital, Yame, Fukuoka, Japan
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65
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McDonnell SM, Boyce G, Baré J, Young D, Shimmin AJ. The incidence of noise generation arising from the large-diameter Delta Motion ceramic total hip bearing. Bone Joint J 2013; 95-B:160-5. [PMID: 23365022 DOI: 10.1302/0301-620x.95b2.30450] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Noise generation has been reported with ceramic-on-ceramic articulations in total hip replacement (THR). This study evaluated 208 consecutive Delta Motion THRs at a mean follow-up of 21 months (12 to 35). There were 141 women and 67 men with a mean age of 59 years (22 to 84). Patients were reviewed clinically and radiologically, and the incidence of noise was determined using a newly described assessment method. Noise production was examined against range of movement, ligamentous laxity, patient-reported outcome scores, activity level and orientation of the acetabular component. There were 143 silent hips (69%), 22 (11%) with noises other than squeaking, 17 (8%) with unreproducible squeaking and 26 (13%) with reproducible squeaking. Hips with reproducible squeaking had a greater mean range of movement (p < 0.001) and mean ligament laxity (p = 0.004), smaller median head size (p = 0.01) and decreased mean acetabular component inclination (p = 0.02) and anteversion angle (p = 0.02) compared with the other groups. There was no relationship between squeaking and age (p = 0.13), height (p = 0.263), weight (p = 0.333), body mass index (p = 0.643), gender (p = 0.07) or patient outcome score (p = 0.422). There were no revisions during follow-up. Despite the surprisingly high incidence of squeaking, all patients remain satisfied with their hip replacement.
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Affiliation(s)
- S M McDonnell
- Knee & Hip Fellow Nuffield Orthopaedic Centre, Oxford, Windmill Road, Headington, Oxford OX3 7LD, UK
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66
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Owen D, Russell N, Chia A, Thomas M. The natural history of ceramic-on-ceramic prosthetic hip squeak and its impact on patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2012; 24:57-61. [PMID: 23412267 DOI: 10.1007/s00590-012-1142-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 11/28/2012] [Indexed: 12/30/2022]
Abstract
BACKGROUND Ceramic-on-ceramic (CoC) total hip arthroplasty (THA) has been scrutinised for a high incidence of post-operative squeak. The psychological and social consequences, and subsequent request for revision surgery are not well documented. METHODS Seventy consecutive primary CoC THA operated on by a single surgeon at a single institution were enroled and followed for an average 7.1 years. Information was obtained from routine post-operative review, medical records, mailed questionnaire and periodic phone interview. RESULTS Of 70 THA, 69 were available for follow-up. Seventeen (24.6 %) reported at least one instance of squeak, occurring on average 34.2 months post-operatively. Five (7.5 %) recalled being warned preoperatively of squeak as a potential complication. Six reported infrequent squeak and 11 frequent squeak. Ten were concerned, reporting embarrassment, harassment and anxiety regarding the longevity of their THA. One patient was planning revision surgery. DISCUSSION This study demonstrates the highest published prevalence of squeaking CoC THA and highlights the importance of warning patients of this potential complication.
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Affiliation(s)
- David Owen
- Department of Orthopaedics and Trauma, The Canberra Hospital, Yamba Drive, Garran, ACT, 2605, Australia
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68
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Kuo FC, Liu HC, Chen WS, Wang JW. Ceramic-on-ceramic total hip arthroplasty: incidence and risk factors of bearing surface-related noises in 125 patients. Orthopedics 2012; 35:e1581-5. [PMID: 23127446 DOI: 10.3928/01477447-20121023-12] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The ceramic-on-ceramic bearing surface has high wear resistance and good biocompatibility in total hip arthroplasty (THA). However, the postoperative noise problem has been an important issue. The purpose of this retrospective study was to determine the incidence and risk factors of bearing surface-related noises in patients with third-generation ceramic-on-ceramic THAs. One hundred twenty-five patients (143 hips) with ceramic-on-ceramic THAs were included in the study and followed to obtain noise and functional results. Patient factors, including sex, age, height, weight, body mass index, diagnosis, and postoperative range of motion, and surgical factors, including cup inclination, ceramic head size and length, and size of cup related to noises, were recorded. Mean follow-up was 4.2 years (range, 2-10 years). Mean Harris Hip Score was 94 points (range, 68-100 points) at latest follow-up. One (0.8%) patient had radiological evidence of osteolysis, and 4 (3.2%) patients had hip dislocation. No hip sustained a fracture of the ceramic component. Eight (6.4%) patients developed noise at their hips, including clicking in 4, grinding in 2, and snapping in 2. No patient developed squeaking hips or underwent revision surgery because of noisy hips. Younger patients (P=.01), a diagnosis of osteonecrosis (P=.014), a 28-mm ceramic head (P=.042), and a higher hip range of motion postoperatively (P=.001) were related to noise in ceramic-on-ceramic THAs. The study showed third-generation ceramic-on-ceramic THAs had a low incidence of noise problems. However, long-term follow-up is necessary to determine the clinical relevance.
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Affiliation(s)
- Feng-Chih Kuo
- Department of Orthopaedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung College of Medicine, Kaohsiung, Taiwan, R.O.C
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Molloy D, Jack C, Esposito C, Walter WL. A mid-term analysis suggests ceramic on ceramic hip arthroplasty is durable with minimal wear and low risk of squeak. HSS J 2012; 8:291-4. [PMID: 24082875 PMCID: PMC3470676 DOI: 10.1007/s11420-012-9291-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 06/22/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND The incidence of hip replacements in the younger patient is ever increasing. With this in mind, improving the longevity of hip arthroplasties is paramount. Alumina ceramic is a promising bearing surface due to its low wear rate and biological inertness. PURPOSE This study aims to review our experience with ceramic-on-ceramic total hip arthroplasty, reporting on the need for revision as well as the cause of failure. Our secondary purpose is to review our experience with the phenomenon of squeaking analysing and its effect on clinical outcome with specific emphasis on component positioning. Also reported are the results of our retrieval analysis of explanted components documenting the wear rate and our analysis of strip wear. METHODS A consecutive series of 301 primary cementless alumina-on-alumina total hip arthroplasties at a minimum of 10 years follow-up was reviewed. These arthroplasties all had third-generation ceramic-on-ceramic bearings performed through a posterior approach with repair of capsule and external rotators to bone. We analysed hips both clinically and radiographically. Analysis of wear in 62 ceramic bearings was performed using a Roundtest RA300 machine (Mitutoyo; Andover, UK), which has an accuracy of 0.01 μm. RESULTS Overall, the survival rate of the implants was 98% at 10 years. No ceramic fractures were encountered in this study. Seventy-four patients reported squeaking hips, and two cases were revised due to squeaking (0.6%). No failures were related to bearing wear. CONCLUSIONS We believe that ceramic-on-ceramic is a safe bearing coupling with excellent survivorship at 10 years.
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Affiliation(s)
- Dennis Molloy
- Sydney Hip and Knee Surgeons, North Sydney, New South Wales Australia
| | - Chris Jack
- Sydney Hip and Knee Surgeons, North Sydney, New South Wales Australia
| | | | - William L. Walter
- Sydney Hip and Knee Surgeons, North Sydney, New South Wales Australia
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Migaud H, Putman S, Combes A, Berton C, Bocquet D, Vasseur L, Girard J. Metal-on-Metal Bearing: Is This the End of the Line? We Do Not Think So. HSS J 2012; 8:262-9. [PMID: 24082870 PMCID: PMC3470659 DOI: 10.1007/s11420-012-9300-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Accepted: 07/05/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recent studies have recommended the discontinuation of metal-on-metal (MoM) components in total hip arthroplasty (THA) because of adverse effects reported with large-diameter MoM THA. This is despite favorable long-term results observed with 28 and 32 mm MoM bearings. QUESTIONS/PURPOSES The aim of this study was to assess the value of calls for an end to MoM bearings as THA components. Specifically, we wish to address the risks associated with MoM bearings including adverse soft tissue reactions, metal ion release, and carcinogenic risk. METHODS The study evaluates the arguments in the literature reporting on MoM (adverse soft tissue reactions, metal ion release, and carcinogenic risk) and the experience of the current authors who re-introduced these bearings in 1995. They are balanced by a benefit-risk review of the literature and the authors' experience with MoM use. RESULTS Adverse reactions to metallic debris as well as metal ion release are predictable and can be prevented by adequate design (arc of coverage, clearance), metallurgy (forged instead of cast alloy, high-carbide content), and appropriate component orientation. There is no scientific evidence that carcinogenicity is increased in subjects with MoM hip prostheses. MoM articulations appear to be attractive allowing safe hip resurfacing, decreasing the risk of THA revision in active patients, and providing secure THA fixation with cement in cages in severely deformed hips. MoM bearings in women of child-bearing age are controversial, but long-term data on metallic devices in adolescents undergoing spinal surgery seem reassuring. DISCUSSION Adequate selection of MoM articulations ensures their safe use. These articulations are sensitive to orientation. Fifteen years of safe experience with 28- and 32-mm bearings of forged alloy and high-carbide content is the main reason for retaining them in primary and revision THA.
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Affiliation(s)
- Henri Migaud
- Department of Orthopedic Surgery, Roger Salengro Hospital, University of Lille, 2 Av Oscar Lambret, 59037 Lille Cedex, France ,Orthopaedics Department, University of Lille, 2 avenue Oscar Lambret, 59037 Lille Cedex, France
| | - Sophie Putman
- Department of Orthopedic Surgery, Roger Salengro Hospital, University of Lille, 2 Av Oscar Lambret, 59037 Lille Cedex, France ,Orthopaedic Department, Lille University Hospital, 2 avenue Oscar Lambret, 59037 Lille Cedex, France
| | - Antoine Combes
- Department of Orthopedic Surgery, Roger Salengro Hospital, University of Lille, 2 Av Oscar Lambret, 59037 Lille Cedex, France ,Orthopaedics Department, University of Lille, 2 avenue Oscar Lambret, 59037 Lille Cedex, France
| | - Charles Berton
- Department of Orthopedic Surgery, Roger Salengro Hospital, University of Lille, 2 Av Oscar Lambret, 59037 Lille Cedex, France ,Orthopaedics Department, University of Lille, 2 avenue Oscar Lambret, 59037 Lille Cedex, France
| | - Donatien Bocquet
- Department of Orthopedic Surgery, Roger Salengro Hospital, University of Lille, 2 Av Oscar Lambret, 59037 Lille Cedex, France ,Orthopaedics Department, University of Lille, 2 avenue Oscar Lambret, 59037 Lille Cedex, France
| | - Laurent Vasseur
- Department of Orthopedic Surgery, Roger Salengro Hospital, University of Lille, 2 Av Oscar Lambret, 59037 Lille Cedex, France ,Orthopaedics Department, University of Lille, 2 avenue Oscar Lambret, 59037 Lille Cedex, France
| | - Julien Girard
- Department of Orthopedic Surgery, Roger Salengro Hospital, University of Lille, 2 Av Oscar Lambret, 59037 Lille Cedex, France ,Department of Sport and Medicine, University of Lille 2, Lille, France ,Orthopaedics Department, University of Lille, 2 avenue Oscar Lambret, 59037 Lille Cedex, France
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Abstract
BACKGROUND Ceramic-on-ceramic (CoC) bearings have excellent tribologic properties because of the smoothness, hardness, and wettability of the material. Therefore, their use has been proposed in younger, active patients who may wear out a traditional metal-on-polyethylene bearing. The same material properties that are beneficial to tribology may also create problems, however. For example, squeaking and fracture of the bearing materials have been reported to occur. PURPOSE The purpose of this paper was to investigate the literature reporting the complications of ceramic bearings and attempt to provide insight into their implications. METHODS The US National Library of Medicine Database (PubMed) was searched using the terms "ceramic-ceramic total hip replacement," "complications," "squeaking," and "fracture." Only clinical studies with a clear reporting of the incidence of these complications were included. RESULTS The literature reports that squeaking of the CoC bearing occurs in a certain percentage of patients and is likely indicative of edge loading and excessive wear. Other factors, such as patient height, weight, range of motion, and implant design, may contribute to the propensity for squeaking. Fracture is a unique risk of the CoC articulation that requires revision surgery. Though improvements in manufacturing techniques have reduced the fracture risk to a very low percentage, the ceramic material remains susceptible to this complication by impingement and component malposition. CONCLUSIONS Because of these possible negative outcomes associated with the ceramic material, the CoC bearing is too unpredictable to use regularly, and its use should be limited to patients who would benefit the most from it.
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72
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Sanders A, Tibbitts I, Brannon R. Concomitant evolution of wear and squeaking in dual-severity, lubricated wear testing of ceramic-on-ceramic hip prostheses. J Orthop Res 2012; 30:1377-83. [PMID: 22354674 PMCID: PMC3374887 DOI: 10.1002/jor.22080] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Accepted: 01/09/2012] [Indexed: 02/04/2023]
Abstract
Ceramic-on-ceramic (CoC) hip bearings were tested in short-term wear tests with a systematically varied contact force. Continuous vibration and intermittent surface roughness measurements were obtained to elucidate potential causes of in vivo hip joint squeaking. The three-phase test comprised alternating cycles of edge loading (EL) and concentric articulation (CA), always using ample serum lubricant. A 50,000-cycle wear trial in which the contact force during CA was distant from the head's wear patch yielded no squeaking and practically no liner roughening. In 10-cycle trials of an edge-worn head coupled with a pristine liner, the contact force was varied in magnitude and point of application; immediate, recurrent squeaking occurred only when the contact force exceeded a critical threshold value and was centered upon the head's wear patch. In a 27,000-cycle wear trial with the contact force applied near the margin of the head's wear patch, recurrent squeaking emerged progressively as the liner's inner surface was roughened via its articulation with the worn portion of the head. The results reveal key conditions that yield recurrent squeaking in vitro in various scenarios without resorting to implausible dry conditions. A fundamental theory explains that hip squeaking is induced by myriad stress waves emanating from asperity collisions; yet, the root cause is edge loading.
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Affiliation(s)
- Anthony Sanders
- Department of Mechanical Engineering, University of Utah, Salt Lake City, Utah, 84112,Ortho Development Corp., 12187 S. Business Park Dr., Draper, UT, 84020
| | - Ira Tibbitts
- Department of Mechanical Engineering, University of Utah, Salt Lake City, Utah, 84112
| | - Rebecca Brannon
- Department of Mechanical Engineering, University of Utah, Salt Lake City, Utah, 84112
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73
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Chen WM, Wu PK, Chen CF, Huang CK, Liu CL, Chen TH. No significant squeaking in total hip arthroplasty: a series of 413 hips in the Asian people. J Arthroplasty 2012; 27:1575-9. [PMID: 22459123 DOI: 10.1016/j.arth.2012.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 02/03/2012] [Indexed: 02/01/2023] Open
Abstract
Some studies have reported the presence of audible squeaking in ceramic-on-ceramic total hip arthroplasty (THA), and several factors such as implant malposition or poor soft tissue recovery have been described as the cause. Our purpose was to determine the squeaking rate in the Asian population with a consecutive series of ceramic-on-ceramic THA. From 2003 to 2009, 413 THAs were performed by a single surgeon using a minimally invasive modified anterior-lateral approach. Using both questionnaire and physical examination, no squeaking was identified in any cases with a minimum of 2-year follow-up. Complications occurred in 4 patients. The results of this study suggested squeaking phenomenon after ceramic-on-ceramic THA may be eliminated.
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Affiliation(s)
- Wei-Ming Chen
- Orthopaedic Department School of Medicine, National Yang-Ming University and Taipei Veterans General Hospital, Taiwan
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74
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Abstract
Over the past three decades, alumina ceramic, now in its third/fourth generation, has been markedly improved in terms of its mechanical properties, including purity, grain microstructure, and burst strength. In the clinic, it is particularly suitable for young and for very active patients. This paper discusses the development and characteristics of different kinds of ceramics. In addition, ceramics in the third/fourth generation which are used in total hip arthroplasty clinically are reviewed in detail.
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Affiliation(s)
- You-zhi Cai
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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75
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Byun JW, Yoon TR, Park KS, Seon JK. Third-generation ceramic-on-ceramic total hip arthroplasty in patients younger than 30 years with osteonecrosis of femoral head. J Arthroplasty 2012; 27:1337-43. [PMID: 22153948 DOI: 10.1016/j.arth.2011.07.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 07/09/2011] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to evaluate the functional and radiographic results of patients younger than 30 years who underwent cementless third-generation ceramic-on-ceramic total hip arthroplasty for osteonecrosis of the femoral head. Forty-one patients (56 hips) with a minimum follow-up of 6 years were included. In all cases, third-generation ceramic-on-ceramic articulation was used. Average Harris Hip Scores improved from 52.9 preoperatively to 98.2, and Western Ontario and McMaster Universities Osteoarthritis Index score, from 95.2 to 25.2. Thirty-nine patients returned to their normal occupations. No aseptic loosening or osteolysis was observed. Total hip arthroplasty performed using third-generation ceramic-on-ceramic bearings for osteonecrosis of femoral head was found to provide satisfactory clinical and radiologic results, especially in active, young patients.
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Affiliation(s)
- Jae-Wook Byun
- Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun-Gun, Jeonnam, South Korea
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76
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Chevillotte C, Pibarot V, Carret JP, Bejui-Hugues J, Guyen O. Hip squeaking: a 10-year follow-up study. J Arthroplasty 2012; 27:1008-13. [PMID: 22425297 DOI: 10.1016/j.arth.2011.11.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2011] [Revised: 09/16/2011] [Accepted: 11/27/2011] [Indexed: 02/01/2023] Open
Abstract
The aim of the study was to analyze the incidence of squeaking with ceramic-on-ceramic total hip arthroplasty (THA) after 10 years of follow-up and the potential complications that could occur related to this phenomenon. One hundred THAs implanted between November 1999 and December 2000 were evaluated. Incidence of squeaking was investigated clinically with a questionnaire. Implant positioning was analyzed on x-rays and computer tomography. Of the 100 THAs, 5 patients presented with squeaking. All of them were active, sporty, and heavy men. Functional scores were comparable with nonsqueaking patients. There was no malpositioning on the x-ray analysis, no wear, and no loosening. We could not demonstrate any relation between squeaking and ceramic fracture. Squeaking noise appeared at a mean of 66 months postsurgery. It appears to be an isolated phenomenon without any consequences at 10-year follow-up.
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Affiliation(s)
- Christophe Chevillotte
- Department of Orthopedic Surgery, Pavillon T, Hôpital Edouard Herriot, Lyon Cedex 03, France
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77
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Haq RU, Park KS, Seon JK, Yoon TR. Squeaking after third-generation ceramic-on-ceramic total hip arthroplasty. J Arthroplasty 2012; 27:909-15. [PMID: 22115760 DOI: 10.1016/j.arth.2011.10.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 10/06/2011] [Indexed: 02/01/2023] Open
Abstract
We retrospectively reviewed records of 1002 patients who underwent a third-generation ceramic-on-ceramic total hip arthroplasty. Fifteen patients complained of squeaking, at any time after their arthroplasty. Of these 15 patients, 14 were evaluated clinically and radiologically. These 14 patients were found to have significantly higher mean body mass index of 25.8 kg/m(2) as compared with all the other patients who did not complain of squeaking (mean, 23.7 kg/m(2)) (P = .022). The acetabular opening angle was significantly lower (mean, 34°) than a matched control group (mean, 38°) (P = .016). Limb length shortening of more than 5 mm was observed in 12 (85.7%) of the 14 patients as compared with only 4 (28.6%) of 14 patients in the matched control group. Flexion and sitting cross legged were identified as the movements, which most commonly (11/12) resulted in squeaking. The incidence of squeaking was found to be low (1.5%), and we identified high body mass index, decreased acetabular opening angle, and limb length shortening as factors associated with squeaking.
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Affiliation(s)
- Rehan-Ul Haq
- Center for Joint Disease, Chonnam National University Hwasun Hospital, 160, Ilsim-Ri, Hwasun-Eup, Hwasun-Gun, Jeonnam, Korea
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78
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Chevillotte C, Trousdale RT, An KN, Padgett D, Wright T. Retrieval analysis of squeaking ceramic implants: are there related specific features? Orthop Traumatol Surg Res 2012; 98:281-7. [PMID: 22459099 DOI: 10.1016/j.otsr.2011.12.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 12/09/2011] [Accepted: 12/15/2011] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Ceramic-on-ceramic total hip arthroplasty is routinely used for young and active patients with end stage of hip osteoarthritis. However, squeaking noise is a recently identified problem with such bearing surface. Many in vivo and in vitro studies have been conducted trying to find the potential causes of this phenomenon. However, we are not aware of any study analyzing retrieved ceramic implants for squeaking. HYPOTHESIS Our primary hypothesis was that the surface analysis of retrieved ceramic implants with squeaking would present interesting deteriorations that could explain the squeaking noise. MATERIALS AND METHODS Nine retrieved squeaking implants from ceramic-on-ceramic total hip arthroplasty that were retrieved for various reasons (two exclusively for squeaking, four for recurrent dislocation, one for aseptic loosening and two for instability) were analyzed. Implant positioning was calculated, macroscopic damages were noticed and microscopic roughness was analyzed. The retrieved implants were then tested on a hip simulator reproducing flexion/extension motions in several situations in lubricated and non-lubricated conditions in order to reproduce squeaking. RESULTS Five cups were considered with borderline insufficient anteversion. Gross impingement damage was visible on seven implants. All the retrieved heads had visible metal transfer on their surface. Eight implants had visible stripe wear. Microscopic analysis showed roughness higher than six microns on the retrieved heads. Squeaking was reproduced in vitro in dry conditions. In lubricated conditions, squeaking did not occur for the retrieved hips. DISCUSSION This retrieval analysis suggests that problems of cup orientation and design which can lead to impingement can generate lubrication problems because of metal transfer plus/minus stripe wear which is a common theme in ceramic-on-ceramic bearings that squeak.
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Affiliation(s)
- C Chevillotte
- T-Pavilion, Department of Orthopaedic Surgery, Edouard-Herriot Hospital, 5, place d'Arsonval, 69437, Lyon cedex 03, France.
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Sugano N, Takao M, Sakai T, Nishii T, Miki H, Ohzono K. Eleven- to 14-year follow-up results of cementless total hip arthroplasty using a third-generation alumina ceramic-on-ceramic bearing. J Arthroplasty 2012; 27:736-41. [PMID: 21978563 DOI: 10.1016/j.arth.2011.08.017] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2011] [Accepted: 08/20/2011] [Indexed: 02/01/2023] Open
Abstract
To analyze long-term survivorship of cementless total hip arthroplasties (THAs) with the third-generation alumina ceramic-on-ceramic bearing, 100 consecutive THAs between 1996 and 1998 were reviewed. One cup and 2 stems were revised due to aseptic loosening. Another cup showed chipping of the acetabular liner at 8 years and required cup revision. The remaining hips showed stable bone ingrowth fixation with no osteolysis at the final follow-up. The 14-year survivorship as the end point of revision was 97.9% for the cup, 97.8% for the stem, and 95.7% for the overall implants, respectively. We conclude that cementless THA with the third-generation ceramic-on-ceramic hip bearing provided an excellent survivorship and eliminated periprosthetic osteolysis for 11 to 14 years.
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Affiliation(s)
- Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
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80
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Nikolaou VS, Edwards MR, Bogoch E, Schemitsch EH, Waddell JP. A prospective randomised controlled trial comparing three alternative bearing surfaces in primary total hip replacement. ACTA ACUST UNITED AC 2012; 94:459-65. [DOI: 10.1302/0301-620x.94b4.27735] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The ideal bearing surface for young patients undergoing total hip replacement (THR) remains controversial. We report the five-year results of a randomised controlled trial comparing the clinical and radiological outcomes of 102 THRs in 91 patients who were < 65 years of age. These patients were randomised to receive a cobalt–chrome on ultra-high-molecular-weight polyethylene, cobalt–chrome on highly cross-linked polyethylene, or a ceramic-on-ceramic bearing. In all, 97 hip replacements in 87 patients were available for review at five years. Two hips had been revised, one for infection and one for peri-prosthetic fracture. At the final follow-up there were no significant differences between the groups for the mean Western Ontario and McMaster Universities osteoarthritis index (pain, p = 0.543; function, p = 0.10; stiffness, p = 0.99), Short Form-12 (physical component, p = 0.878; mental component, p = 0.818) or Harris hip scores (p = 0.22). Radiological outcomes revealed no significant wear in the ceramic group. Comparison of standard and highly cross-linked polyethylene, however, revealed an almost threefold difference in the mean annual linear wear rates (0.151 mm/year versus 0.059 mm/year, respectively) (p < 0.001).
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Affiliation(s)
- V. S. Nikolaou
- St Michael’s Hospital, 30
Bond Street, Toronto, Ontario
M5B 1WB, Canada
| | - M. R. Edwards
- Princess Royal University Hospital, Farnborough
Hill, Orpington, Kent
BR6 8ND, UK
| | - E. Bogoch
- St Michael’s Hospital, 30
Bond Street, Toronto, Ontario
M5B 1WB, Canada
| | - E. H. Schemitsch
- St Michael’s Hospital, 30
Bond Street, Toronto, Ontario
M5B 1WB, Canada
| | - J. P. Waddell
- St Michael’s Hospital, 30
Bond Street, Toronto, Ontario
M5B 1WB, Canada
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81
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Stanat SJC, Capozzi JD. Squeaking in third- and fourth-generation ceramic-on-ceramic total hip arthroplasty: meta-analysis and systematic review. J Arthroplasty 2012; 27:445-53. [PMID: 21676580 DOI: 10.1016/j.arth.2011.04.031] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2010] [Accepted: 04/21/2011] [Indexed: 02/01/2023] Open
Abstract
Postoperative squeaking in ceramic-on-ceramic total hip arthroplasty is a recently emerging phenomenon. We performed a meta-analysis of published data to examine patient and procedural risk factors. Twelve studies (6137 patients, total) were analyzed, with 150 patients (2.4%) complaining of squeaking. The only significant patient risk factor was increasing body mass index (P = .03, n = 2957). There was no significance found with patient age, sex, height, weight, or procedural laterality for squeak incidence. For implant type, the presence of a Stryker Accolade femoral stem (beta-titanium; Stryker Orthopedics, Mahwah, NJ) was significantly found to increase squeak (P < .0001, n = 4654). The presence of a raised metallic lip on the acetabular component was not found to be associated with squeak. Acetabular cup position was also not found to have a significant bearing on the incidence of squeaking.
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Affiliation(s)
- Scott J C Stanat
- Stony Brook University Medical Center, Department of Orthopaedics, Stony Brook, New York 11794-8181, USA
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82
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Sariali E, Jin Z, Stewart T, Fisher J. Spectral characterization of squeaking in ceramic-on-ceramic total hip arthroplasty: comparison of in vitro and in vivo values. J Orthop Res 2012; 30:185-9. [PMID: 21834123 DOI: 10.1002/jor.21510] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 06/30/2011] [Indexed: 02/04/2023]
Abstract
Squeaking is a cause for concern in total hip arthroplasty (THA). However, the definition of this sound remains vague. Our goals were to characterize spectrally the squeaking in vitro under lubricated conditions and to compare the in vitro frequencies to in vivo frequencies. Four patients, who presented with a squeaking after ceramic-on-ceramic THA were investigated. In addition, 3 alumina ceramic 32 mm diameter components were tested in vitro under edge loading conditions using a friction simulator. Tests were conducted under lubricated conditions without and with the addition of a third body alumina particle. In vitro, no squeaking occurred under edge loading conditions. However, with the addition of a third body particle in the contact region, squeaking was obtained; the dominant frequency was 2.6 kHz. In vivo, the main recorded sound frequencies were: 2.3, 2.24, and 2.46 kHz for squeakers during walking and 1.45 kHz for a squeaker rising from a bent position. The in vivo recordings had a dominant frequency similar to, but slightly lower than, the in vitro values. Two types of squeaking were found in vivo and characterized spectrally. The rising squeaker had intermittent squeaking corresponding to a lower fundamental frequency compared to the walking squeakers. This finding suggests two different mechanism of squeaking.
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Affiliation(s)
- Elhadi Sariali
- IMBE Leeds University, Leeds, United Kingdom; Orthopaedic Surgery Department, Hopital Pitié Salpétrière, 47-83 Boulevard de l'Hopital, 75013 Paris, France.
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83
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Tomek IM, Currier JH, Mayor MB, Van Citters DW. Metal transfer on a ceramic head with a single rim contact. J Arthroplasty 2012; 27:324.e1-4. [PMID: 21440409 DOI: 10.1016/j.arth.2011.02.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 02/12/2011] [Indexed: 02/01/2023] Open
Abstract
A notable feature of retrieved ceramic-on-ceramic hips is metal transfer on the femoral head, which is an important alteration of the bearing surface. This report documents metal transfer streaks on a ceramic femoral head resulting from discrete subluxations, which occurred intraoperatively during reduction and stability testing. An important implication is that metal transfer can occur whenever a femoral head is reduced into the liner during surgery or from in vivo subluxation/dislocation. If a ceramic liner is recessed below a raised metal rim, care should be taken to prevent head-to-rim contact during intraoperative reductions and stability testing. If metal transfer occurs during final surgical reduction of the hip, its presence may remain undetected, and detrimental effects are present from the time of surgery.
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Affiliation(s)
- Ivan M Tomek
- Dartmouth Hitchcock Medical Center, Hanover, New Hampshire, USA
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84
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Walter WL, Kurtz SM, Esposito C, Hozack W, Holley KG, Garino JP, Tuke MA. Retrieval analysis of squeaking alumina ceramic-on-ceramic bearings. ACTA ACUST UNITED AC 2012; 93:1597-601. [PMID: 22161920 DOI: 10.1302/0301-620x.93b12.27529] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This multicentre study analysed 12 alumina ceramic-on-ceramic components retrieved from squeaking total hip replacements after a mean of 23 months in situ (11 to 61). The rates and patterns of wear seen in these squeaking hips were compared with those seen in matched controls using retrieval data from 33 'silent' hip replacements with similar ceramic bearings. All 12 bearings showed evidence characteristic of edge-loading wear. The median rate of volumetric wear was 3.4 mm(3)/year for the acetabular component, 2.9 mm(3)/year on the femoral heads and 6.3 mm(3)/year for head and insert combined. This was up to 45 times greater than that of previously reported silent ceramic-on-ceramic retrievals. The rate of wear seen in ceramic components revised for squeaking hips appears to be much greater than in that seen in retrievals from 'silent' hips.
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Affiliation(s)
- W L Walter
- Specialist Orthopaedic Group, Suite 1.08 Mater Clinic, 3-9 Gillies Street, Wollstonecraft, New South Wales 2065, Australia.
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85
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Yeung E, Bott PT, Chana R, Jackson MP, Holloway I, Walter WL, Zicat BA, Walter WK. Mid-term results of third-generation alumina-on-alumina ceramic bearings in cementless total hip arthroplasty: a ten-year minimum follow-up. J Bone Joint Surg Am 2012; 94:138-44. [PMID: 22258000 DOI: 10.2106/jbjs.j.00331] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Alumina ceramic-on-ceramic bearings have gained popularity in hip arthroplasty because of their properties of low wear and chemical inertness. In a previous study, we reported the excellent clinical results in a series of cementless ceramic-on-ceramic primary total hip arthroplasties at a minimum of five years of follow-up. The purpose of the present study was to determine the results in the same patient cohort at a minimum of ten years of follow-up. METHODS A series of 301 consecutive primary cementless total hip arthroplasties was assessed clinically and radiographically. Clinical information was available for 244 hips in 227 surviving patients at a minimum of ten years of follow-up, and radiographic information was available for 184 hips in 172 patients. RESULTS Twenty-six (9.2%) of the patients had died of an unrelated cause and eight (2.7%) had undergone revision arthroplasty by the time of the latest follow-up. The average Harris hip score was 94 points, with 95% (232) of the patients having an excellent or good result and <4% (nine) having moderate residual pain. All radiographic assessments showed evidence of stable osseous ingrowth. Nine revisions had been performed, including four femoral component revisions due to periprosthetic fracture, one femoral revision due to aseptic loosening, one femoral revision secondary to a femoral shortening osteotomy for nerve palsy, two acetabular cup revisions due to psoas tendinitis, and a repeat revision in one of the patients with psoas tendinitis due to acetabular osteolysis. The overall survival rate of the implants was 98% (95% confidence interval, 94.2% to 99.6%) at ten years with revision for any reason as the end point. CONCLUSIONS The patients in our series had a good implant survival rate, good function, a low implant wear rate as reported in the previous study, and no further radiographic evidence of failure at ten years after cementless primary total hip arthroplasty with alumina ceramic-on-ceramic bearings.
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Affiliation(s)
- Eric Yeung
- Specialist Orthopaedic Group, Suite 1.08, 3-9 Gillies Street, North Sydney, NSW 2060, Australia.
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86
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Solarino G, Piazzolla A, Notarnicola A, Moretti L, Tafuri S, De Giorgi S, Moretti B. Long-term results of 32-mm alumina-on-alumina THA for avascular necrosis of the femoral head. J Orthop Traumatol 2012; 13:21-7. [PMID: 22249776 PMCID: PMC3284675 DOI: 10.1007/s10195-011-0174-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Accepted: 12/04/2011] [Indexed: 11/17/2022] Open
Abstract
Background Ceramic bearings in total hip arthroplasty (THA) have been introduced in clinical practice to minimize the problem of polyethylene particle–induced osteolysis. The aim of the study is to report the results of 68 consecutive alumina-on-alumina THAs done in 61 patients for avascular necrosis (AVN) of the femoral head. Materials and methods In all implants a press-fit cup was used; it was combined with a 32-mm alumina head and with titanium-alloy stems. The mean age at surgery was 50 years. At an average follow-up of 13 years two hips have been revised, one for periprosthetic infection and one for excessive abduction of the cup. Results No revision for aseptic loosening is recorded; one anatomical cementless femoral stem had radiological evidence of definite aseptic loosening. No dislocations occurred, and no osteolysis was observed. Conclusions The results support the application of alumina-alumina THA for long-lasting replacements.
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Affiliation(s)
- Giuseppe Solarino
- Department of Neuroscience and Sense Organs, Orthopaedic and Traumatology Unit, Faculty of Medicine and Surgery, General Hospital, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
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87
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Weiss C, Hothan A, Huber G, Morlock MM, Hoffmann NP. Friction-induced whirl vibration: Root cause of squeaking in total hip arthroplasty. J Biomech 2012; 45:297-303. [DOI: 10.1016/j.jbiomech.2011.10.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 10/17/2011] [Accepted: 10/22/2011] [Indexed: 12/12/2022]
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Sanders AP, Dudhiya PJ, Brannon RM. Thin hard crest on the edge of ceramic acetabular liners accelerates wear in edge loading. J Arthroplasty 2012; 27:150-2. [PMID: 21978562 PMCID: PMC3237780 DOI: 10.1016/j.arth.2011.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 08/14/2011] [Indexed: 02/01/2023] Open
Abstract
Ceramic acetabular liners may exhibit a small, sharp crest-an artifact of discontinuous machining steps--at the junction between the concave spherical surface and the interior edge. On 3 ceramic liners, this crest was found to form a 9° to 11° deviation from tangency. Edge loading wear tests were conducted directly on this crest and on a smoother region of the edge. The crest elicited 2 to 15 times greater volumetric wear on the femoral head. The propensity of the crest to rapidly (<2000 wear cycles) cause elevated wear under low contact force (200 N) suggests that the crest artifact of prevailing machining protocols might be a root cause of stripe wear and squeaking in ceramic acetabular bearings.
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Affiliation(s)
- Anthony P. Sanders
- Department of Mechanical Engineering, University of Utah, 50 S. Central Campus Dr., Salt Lake City, UT 84112, Phone: 801-949-4261, Fax: 801-619-8936,
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89
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Swaminathan V, Zeng H, Lawrynowicz D, Zhang Z, Gilbert JL. Electrochemical investigation of chromium nanocarbide coated Ti–6Al–4V and Co–Cr–Mo alloy substrates. Electrochim Acta 2012. [DOI: 10.1016/j.electacta.2011.10.085] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Thorey F, Sakdinakiattikoon M, Thiengwittayaporn S, Windhagen H. Early Results of Revision Hip Arthroplasty Using a Ceramic Revision Ball Head. ACTA ACUST UNITED AC 2011. [DOI: 10.1053/j.sart.2011.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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91
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Zywiel MG, Sayeed SA, Johnson AJ, Schmalzried TP, Mont MA. State of the art in hard-on-hard bearings: how did we get here and what have we achieved? Expert Rev Med Devices 2011; 8:187-207. [PMID: 21627555 DOI: 10.1586/erd.10.75] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Total hip arthroplasty has shown excellent results in decreasing pain and improving function in patients with degenerative disease of the hip. Improvements in prosthetic materials, designs and implant fixation have now resulted in wear of the bearing surface being the limitation of this technology, and a number of hard-on-hard couples have been introduced to address this concern. The purpose of this article is to review the origins, development, survival rates and potential advantages and disadvantages of the following hard-on-hard bearings for total hip arthroplasty: metal-on-metal standard total hip arthroplasty; metal-on-metal hip resurfacing arthroplasty, ceramic-on-ceramic total hip arthroplasty; and ceramic-on-metal bearings. Improvements in the manufacturing of metal-on-metal bearings over the past 50 years have resulted in implants that provide low wear rates and allow for the use of large femoral heads. However, concerns remain regarding elevated serum metal ion levels, potential teratogenic effects and potentially devastating adverse local tissue reactions, whose incidence and pathogenesis remains unclear. Modern total hip resurfacing has shown excellent outcomes over 10 years in the hands of experienced surgeons. Current ceramic-on-ceramic bearings have demonstrated excellent survival with exceptionally low wear rates and virtually no local adverse effects. Concerns remain for insertional chipping, in vivo fracture and the variable incidence of squeaking. Contemporary ceramic-on-metal interfaces are in the early stages of clinical use, with little data reported to date. Hard-on-hard bearings for total hip arthroplasty have improved dramatically over the past 50 years. As bearing designs continue to improve with new and modified materials and improved manufacturing techniques, it is likely that the use of hard-on-hard bearings will continue to increase, especially in young and active patients.
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Affiliation(s)
- Michael G Zywiel
- Division of Orthopaedic Surgery, University of Toronto, 100 College Street Room 302, Toronto, Ontario M5G 1L5, Canada
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92
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Is metal-on-metal squeaking related to acetabular angle of inclination? Clin Orthop Relat Res 2011; 469:2577-82. [PMID: 21512812 PMCID: PMC3148366 DOI: 10.1007/s11999-011-1900-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Accepted: 04/08/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND Postoperative audible squeaking has been well documented in ceramic-on-ceramic hip prostheses, and several metal-on-metal (MOM) THA designs, specifically those used for large-head resurfacing and MOM polyethylene sandwich designs, and are attributed to different implant- and patient-specific factors. Current literature does not identify the incidence of squeaking in modular MOM THA or possible etiologic factors. QUESTIONS/PURPOSES Our purposes were to (1) identify the incidence of squeaking in modular MOM prostheses in THA; (2) determine whether males or females were more likely to have squeaking; and (3) determine whether the incidence of squeaking relates to acetabular inclination angle. METHODS We retrospectively reviewed the patient records and radiographs of 539 patients (542 hips) from three independent centers who underwent a MOM THA between February 2001 and December 2005. Demographic and implant factors were evaluated, including measurement of cup inclination angles. The minimum followup was 36 months (mean, 76 months; range, 36-119 months). RESULTS We identified squeaking in eight of the 542 hips (1.5%); five were in women and two were in men (one patient had bilateral squeaking). The time to onset of patient-reported audible squeaking averaged 23 months (range, 6-84 months). Squeaking was more likely to occur in women (six of eight hips). No hips with 45º or less acetabular inclination squeaked (291 hips); eight of 251 hips (3.2%) with inclination angles greater than 45º squeaked. Patients who reported squeaking had higher inclination angles than those who did not report squeaking. CONCLUSIONS Our observations suggest an increased frequency of squeaking in female patients and in patients with greater inclination angles with this MOM implant design.
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93
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Parvizi J, Adeli B, Wong JC, Restrepo C, Rothman RH. A squeaky reputation: the problem may be design-dependent. Clin Orthop Relat Res 2011; 469:1598-605. [PMID: 21274762 PMCID: PMC3094607 DOI: 10.1007/s11999-011-1777-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Squeaking is reportedly a complication in patients having ceramic-on-ceramic total hip implants. The etiology remains unknown and multifactorial with recent studies suggesting a relationship between the audible squeak and implant design. When we evaluated our ceramic-on-ceramic cohort, we noticed squeaking primarily in patients receiving an acetabular system designed with an elevated titanium rim. OBJECTIVES/PURPOSES We therefore (1) determined the incidence of squeaking among four different ceramic-on-ceramic bearing surfaces used for THA at our institution; (2) evaluated the association between different acetabular designs and the incidence of squeaking; and (3) assessed other potential variables associated with squeaking. METHODS We retrospectively reviewed 1507 patients having a ceramic-on-ceramic THA between 2002 and 2009; we separately analyzed those receiving an acetabular system with and without an elevated titanium rim. Data were collected through phone-administered questionnaires and retrospective reviews of patient charts for intraoperative findings, followup reports, demographic information, and radiographic findings. RESULTS Squeaking occurred in 92 of the 1507 patients (6%). All 92 patients with squeaking received an elevated rim design (1291 patients) or an incidence of 7% with that design. We found no association between squeaking and any other examined factors. CONCLUSION Our findings complement the theory from in vitro studies suggesting that neck impingement on the elevated titanium rim is the probable cause of the increased frequency of squeaking with this design.
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Affiliation(s)
- Javad Parvizi
- The Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107 USA
| | - Bahar Adeli
- The Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107 USA
| | - Justin C. Wong
- The Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107 USA
| | - Camilo Restrepo
- The Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107 USA
| | - Richard H. Rothman
- The Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107 USA
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Laurent MP, Pourzal R, Fischer A, Bertin KC, Jacobs JJ, Wimmer MA. In vivo wear of a squeaky alumina-on-alumina hip prosthesis: a case report. J Bone Joint Surg Am 2011; 93:e27. [PMID: 21471407 PMCID: PMC6882528 DOI: 10.2106/jbjs.i.00930] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Michel P. Laurent
- Department of Orthopaedic Surgery, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612. E-mail address for M.P. Laurent: . E-mail address for J.J. Jacobs: . E-mail address for M.A. Wimmer:
| | - Robin Pourzal
- Materials Science and Engineering, University of Duisburg-Essen, Lotharstrasse 1, 47057 Duisburg, Germany. E-mail address for R. Pourzal: . E-mail address for A. Fischer:
| | - Alfons Fischer
- Materials Science and Engineering, University of Duisburg-Essen, Lotharstrasse 1, 47057 Duisburg, Germany. E-mail address for R. Pourzal: . E-mail address for A. Fischer:
| | - Kim C. Bertin
- Utah Bone & Joint Center, 5323 Woodrow Street #202, Salt Lake City, UT 84107
| | - Joshua J. Jacobs
- Department of Orthopaedic Surgery, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612. E-mail address for M.P. Laurent: . E-mail address for J.J. Jacobs: . E-mail address for M.A. Wimmer:
| | - Markus A. Wimmer
- Department of Orthopaedic Surgery, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612. E-mail address for M.P. Laurent: . E-mail address for J.J. Jacobs: . E-mail address for M.A. Wimmer:
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Cogan A, Nizard R, Sedel L. Occurrence of noise in alumina-on-alumina total hip arthroplasty. A survey on 284 consecutive hips. Orthop Traumatol Surg Res 2011; 97:206-10. [PMID: 21388904 DOI: 10.1016/j.otsr.2010.11.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Revised: 11/14/2010] [Accepted: 11/30/2010] [Indexed: 02/02/2023]
Abstract
BACKGROUND Alumina-on-alumina bearings have been accepted as a valuable alternative for young and active patients. Alumina fractures, and socket loosening were the main complications reported. But, with the increasing number of prostheses implanted, noise occurrence appeared as a new concern. The primary aim of the present study was to quantify the prevalence of noticing noise in a population having received alumina-on-alumina total hip arthroplasty as well as its eventual impact on outcome. PATIENTS AND METHODS Two hundred and eighty-four ceramic-on-ceramic hips were performed in 238 patients from January 2003 to December 2004. The average age was 52.4 ± 13.4 years (range, 13 to 74 years). All the hips received the same prosthesis (Ceraver-Osteal™) with alumina bearing components (Ceraver-Osteal™): 32 mm liners were used for cups of 50mm or larger and 28 mm liners for cups smaller than 48 mm; the minimal alumina thickness was 6mm. The acetabular component (Cerafit™) was hemispherical, coated with a hydroxyapatite layer and press-fit fixed. The stem (Cerafit™) was a straight tapered cementless stem, fully coated with a hydroxyapatite layer. Clearance between femoral head and liner was between 20 and 50 microns. A retrospective survey was conducted by an independent surgeon who did not participate to surgery in 2007. He conducted phone interviews of patients using a standard questionnaire. No suggestion was offered on how they could describe the noise and they felt free to use the word that they considered to be the most adapted. Satisfaction was evaluated. When the noise was present, X-rays were taken to assess if sign of bearings fracture was present. RESULTS Four patients (six hips) died of unrelated causes during the follow-up period. Three patients (three hips) live outside France and could not be followed (1.3%). Nine patients (10 hips) could not be traced and were considered lost to follow-up (3.8%). Two hundred and twenty-two patients with 265 hips, therefore, were included (nine using bearing components in 28 mm diameter and 265 in 32 mm). Twenty-eight hips experienced noise generation (10.6%). It was defined as a snap for six patients, as a cracking sound by six, as rustling by six patients, as a squeaking by seven patients (2.6%), a tinkling by two patients, one patient was unable to define the sound she felt. No factor related to the patient influenced the occurrence of noise. Twelve patients were dissatisfied with the result of their hip prosthesis, five of them experienced noise (41.7%); 210 were satisfied or very satisfied, 23 of them experiencing noise (11%); this difference was significant (P=0.002). CONCLUSION The origins of noise occurrence are unknown. Squeaking may be related to generation of stripe wear and absence of sufficient lubrication. Other types of noise can be due to microseparation, occult dislocation, impingement between the femoral neck and the acetabular rim. LEVEL OF EVIDENCE Level IV. Retrospective study.
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Affiliation(s)
- A Cogan
- Department of Orthopaedics and Traumatology, Lariboisière Hospital, 2, rue Ambroise-Paré, 75010 Paris, France.
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96
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Schroder D, Bornstein L, Bostrom MPG, Nestor BJ, Padgett DE, Westrich GH. Ceramic-on-ceramic total hip arthroplasty: incidence of instability and noise. Clin Orthop Relat Res 2011; 469:437-42. [PMID: 20852972 PMCID: PMC3018215 DOI: 10.1007/s11999-010-1574-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Alternative bearing materials in THA have been developed to reduce the incidence of osteolysis. Alumina-on-alumina bearings exhibit extremely low wear rates in vitro, but concerns exist regarding component impingement with the potential for dislocation and the occurrence of noise. QUESTIONS/PURPOSES We determined generation of squeaking and the relationship between squeaking and component position. METHODS We prospectively entered 436 alumina-on-alumina, cementless, primary THAs in 364 patients into our institutional database. All procedures were performed with the same surgical technique and the same implant. We obtained Harris Hip scores and a noise questionnaire and assessed radiographic component position and loosening. We determined the difference in abduction angle between squeakers and nonsqueakers. Minimum followup was 2 years (average, 3.5 years; range, 2.0-6.2 years). RESULTS The mean Harris hip score increased from 51.9 preoperatively to 94.4 at latest followup. Six hips underwent reoperation: four hips (1.1%) for dislocation and two (0.53%) for periprosthetic fracture after trauma. The incidence of noise of any type was 11%, with the most common type of noise being clicking or snapping. Squeaking was reported by 1.9% of patients, with no patient being revised for this phenomenon. We found no association between component position and squeaking. CONCLUSIONS At average 3 years followup, 98% of ceramic-on-ceramic THAs did not require a revision, with 1.1% of hips having been revised for dislocation. Fewer than 2% of patients reported hearing an audible squeak, with no association found between component position and squeaking. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- David Schroder
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY USA
| | - Lindsey Bornstein
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY USA
| | - Mathias P. G. Bostrom
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New York, NY 10021 USA
| | - Bryan J. Nestor
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New York, NY 10021 USA
| | - Douglas E. Padgett
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New York, NY 10021 USA
| | - Geoffrey H. Westrich
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New York, NY 10021 USA
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97
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Squeaking sound in total hip arthroplasty using ceramic-on-ceramic bearing surfaces. J Orthop Sci 2011; 16:21-5. [PMID: 21249404 DOI: 10.1007/s00776-010-0005-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Accepted: 08/31/2010] [Indexed: 02/09/2023]
Abstract
PURPOSE To evaluate the causes and frequency of the squeaking sound in ceramic-on-ceramic THA. MATERIALS AND METHODS This study included 61 hips of 50 patients who underwent ceramic-on-ceramic THA in our hospital from March 1999 to April 2005. The average age at the time of operation was 57.6 years. The average duration of follow-up was 69.5 months. Three different acetabular components were used: Osteonics (Stryker, USA: 24 cases), Bicontact (Aesculap, Germany: 27 cases) and ABG (Howmedica, UK: 10 cases). RESULTS Fourteen (22.9%) of the 61 cases had a squeaking sound, and this sound started a mean of 47.57 months after the operation. Except in one case, the squeaking sound remained until the last follow-up. There was no difference in acetabular component position between the squeaking and nonsqueaking groups. The squeaking sound was found to be related to the BMI (body mass index) and cup design. It occurred frequently in patients with high BMI who had received a total hip arthroplasty using an Osteonics cup. Among 11 of the patients, squeaking occurred while squatting, and in 3 patients while walking. Six patients suffered from mild restrictions on their activities of daily living, and 8 had more than moderate restrictions with squeaking sounds. CONCLUSION A squeaking sound in THA using ceramic-on-ceramic surfaces is not a rare complication, and often affects the patient's behavior.
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98
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Abstract
BACKGROUND The alumina-on-alumina bearing surface, which has a high wear resistance and a good biocompatibility, is widely used in THA but recently has been associated with squeaking. While various authors have reported factors associated with squeaking, they remain poorly understood. QUESTIONS/PURPOSES To contribute to the debate on squeaking we therefore asked the following questions: (1) What is the incidence of squeaking in alumina-on-alumina THA? (2) What factors are associated with squeaking in alumina bearings in our practice? METHODS We retrospectively reviewed 168 patients (173 hips) who had primary alumina-on-alumina THAs. The mean age of the patients was 53 years (range, 18 to 81 years). Minimum followup was 5.6 years (average, 7.3 years; range, 5.6-9.4 years). All patients were evaluated clinically and radiographically with attention to periprosthetic osteolysis, squeaking, and ceramic fracture. When the patient reported squeaking, we determined the onset, reproducibility, and activities associated with the squeaking. We recorded patient (gender, age, height, weight, and body mass index) and surgical factors (abduction angle of cup, size and length of ceramic head component, and diameter of cup in the implant). RESULTS Eight of the 168 patients (5%) had squeaking hips. Squeaking was more common in males and in those with large ceramic heads. There were no complications or revisions in the squeaking group. One ceramic liner fracture was associated with trochanteric nonunion. CONCLUSIONS When recommending alumina-on-alumina bearing surfaces to patients they should be clearly informed of the possibility of squeaking. Patients with risk factors for squeaking should be followed at regular intervals.
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99
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Katz JN, Earp BE, Gomoll AH. Surgical management of osteoarthritis. Arthritis Care Res (Hoboken) 2010; 62:1220-8. [PMID: 20506552 DOI: 10.1002/acr.20231] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Jeffrey N Katz
- Brigham and Women's Hospital and Harvard University, Boston, Massachusetts, USA.
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100
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Matar WY, Restrepo C, Parvizi J, Kurtz SM, Hozack WJ. Revision hip arthroplasty for ceramic-on-ceramic squeaking hips does not compromise the results. J Arthroplasty 2010; 25:81-6. [PMID: 20637562 DOI: 10.1016/j.arth.2010.05.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2009] [Accepted: 05/03/2010] [Indexed: 02/01/2023] Open
Abstract
Squeaking is a complication that may occur after ceramic-on-ceramic total hip arthroplasty (THA) that can be intolerable enough for some patients to seek revision THA. This prospective case series of 11 hips is the first to report on the results of these patients. All patients underwent isolated head and liner exchange to a metal-on-highly cross-linked polyethylene using the direct lateral approach. Mean age was 45.5 years, and body mass index was 30.0 kg/m(2). Hips were revised at an average of 40.1 months postindex THA. Retrieval analysis showed 7 of 7 liners/heads with edge loading wear and 5 of 7 liners with signs of neck-rim impingement. Short Form-36 mental dimension, Western Ontario McMaster Osteoarthritis Index, and Harris Hip Score (HHS) showed a statistically significant improvement (P < .05). All squeaking was eliminated after revision THA. There were no morbidities or complications after the revision surgery rendering isolated head-and-liner exchange to a metal-on-highly cross-linked polyethylene a relatively benign procedure.
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Affiliation(s)
- Wadih Y Matar
- Rothman Institute of Orthopedics, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA
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